September 07, 2023
Episode 36: Will we ever get payors and providers to speak the same love language? Russ Thomas of Availity thinks we can – and has a roadmap to do so
In the U.S., payors and providers need each other to deliver the highest-quality care at the lowest cost—but they don’t always get along. Russ Thomas, CEO of Availity, joins Justin to discuss the systemic factors driving the misalignment between payors and providers. Russ and Justin discuss how technology and a new perspective might be able to simplify two of biggest points of friction: utilization management and authorization workflow.
Justin and Russ ask the tricky questions facing our overly complicated system of healthcare reimbursement: How can payors and providers create more transparency in the claims process? Can AI and other tech solve payors’ yield problems? And is a single-payor system really the answer to our healthcare woes?
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Definitively Speaking is a definitive healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com. Hello and welcome to another episode of Definitively Speaking, the podcast where we have data-driven conversations on the current state of healthcare. I’m Justin Steinman, Chief Marketing Officer at Definitive Health Healthcare and your host for this podcast. Peanut butter and jelly, hot dogs and mustard, the Red Sox and World Series Championships. Some things just belong together, even if they’re not always obvious or easy to put together. Payers and providers are no different. They belong together. They need each other, but they don’t always like each other. Sure, their objectives are the same, keeping you AKA, the patient, healthy. But payers and providers frequently differ on what the right course of treatment is, how much it should cost, and who should pay. Fortunately, or unfortunately, and I’ll let you decide which the two options it is, payers and providers are stuck with each other. We sure don’t want that healthcare provider to go away, otherwise who’s gonna take care of us? And these providers need to get paid and reimbursed for their services. So like it or not, payers and providers have to figure out how to work together, a collaboration that never stops, and a collaboration that could always use some sort of improvement. My guest today has a unique perspective on this collaboration. In fact, you might see that he sits at the Center of payer provider collaboration, even though he is neither a payer nor a provider. Russ Thomas is the CEO of Availity, one of the nation’s largest health information networks. Availity facilitates billions of clinical, administrative, and financial transactions annually. They work to solve communication challenges in healthcare by creating a richer, more transparent exchange of information among health plans, providers and technology partners. I’m thrilled to have Russ on the show today and I cannot wait to hear his perspective on why payer and providers have a love hate, and a love to hate, but I need you, relationship. Russ, welcome to Definitively Speaking.
Hey Justin, great to see you.
Great to see you too. Appreciate you joining us from Montana. Your work away-cation is what you think you’re calling this?
It is something like that. Well, you know, everybody has these staycations where you stay at home and vacation. So I came up with my own concept I call a workaway, where I leave 95 degree, 100% humidity Florida for a couple of weeks and come out here to Montana where it’s absolutely beautiful. And I work from here for a couple of weeks.
That’s awesome. I wish we weren’t only audio today ‘cause then our audience could see the log cabin that you are in with I’m sure lots of dead animals on the wall surrounding you. So let’s jump right in. Russ, what’s the latest status of payer provider collaboration?
Great question. Great place to start. You know, I’ve been at this, Justin, for a while, right? I’ve been at Availity since 2008 and I think we’ve uniquely held, as you described, this sort of center position, if you will. I sometimes call it the demilitarized zone between payers and providers. And I’m a generally pretty optimistic person, but even as optimistic as I am, I feel like we’re in a pretty good place with payer provider collaboration right now. You know, you look at our network, we’ve got 30+ of the largest plans in the country that exclusively engage with their provider networks through us. And I think at last count, just over 3 million active providers in the network. And we’ll process 13 billion transactions, or something like that, this year. So I think we’ve got a pretty unique perspective to assess the state of the relationship. And there’s a lot of real positives, right? I mean, I think if you come up at the sort of macro-level, you say, wow, you’ve still got hundreds and hundreds of billions of dollars of administrative inefficiency in healthcare and all the constant stories about providers not being able to get paid timely, and understand why they’re getting paid the way they are. And there’s still a ton of that for sure. But down in the bowels of the ship where the engine room is humming, there is a lot of really good activity happening between innovative people, ‘cause it’s a people business, and both health plans and providers trying to improve the quality of engagement.
What are some of those innovative things?
So, I’m a use case driven thinker. You know, a lot of folks can sit up and talk about, collaboration and strategies around it and all that sort of stuff. But at the end of the day, the question is, what’s getting done, right? What’s actually changing that is improving the overall quality of the relationship? So I’ll point to a couple of things. I think that we are making good progress in what we all know is one of the biggest pain points for providers in particular, payers as well, but it’s just not as publicly identified, I think. And that is the utilization management authorization workflow, right? So, bane of provider’s existence, I think for a couple of reasons. I think sort of psychologically providers would say, look, you know, we went to med school to figure out how to treat people. We don’t need a payer to tell us whether a procedure is medically necessary or not. But then you have the payer perspective, right? Which is somewhere between, our job is to manage utilization. That’s what we get paid to do to make sure that our members are receiving, the right care, the right treatment, things that are needed because it’s not free. And we actually have a lot more data about the member. You as a provider know what you know in that moment of an encounter, but we have a broader, more comprehensive view of what’s going on in a patient. So when it comes to complex issues like this, I always sort of look at intent, and I generally believe that the provider intent is to deliver the right care to the right patient at the right time, right? The payer intent is to make sure that patients are being treated appropriately, both from a medical perspective, as well as from a financial perspective, and that they’re not having procedures done that aren’t necessary. So I think intent is good on both sides of the house. So then you get down to sort of language, right? And the language of authorizations is particularly complex because unlike standard transactions like claims and eligibility and things like that, an authorization is both an administrative and a clinical transaction. It’s a clinical event, right? You’re having some procedure performed that the plan has said, before you do this, you gotta go do a mother may I. So where I think the relationship breaks down quite often there is in language, right? So providers speak clinical, payers speak billing and payment and ICD-10 and X12 and it’s just a real difference in language, which is where I think companies like ours come in, and I’m not gonna make this an Availity commercial, but there’s a great opportunity for someone to sit in the middle of that conversation between a payer and provider and to translate provider intent into payer language and payer response into provider language. And what I see is a broad desire on the part of both payers and providers to simplify that workflow. Providers will say, look, I can live with you telling me something’s not medically necessary if you tell me that pre-service and if you can tell me that very quickly, but to tell me something’s not medically necessary after I’ve performed the procedure and incurred the cost of doing it, and now you’re denying my claim, doesn’t feel like a very fair way to run a railroad. But that’s an example, right? I think that’s sort of the most current one in my mind of where you’ve got two sides really trying to do things differently and to achieve a better result on behalf of the patient.
You know, but it really comes down to that word, and you use it a couple times, “necessary.” It’s who decides what’s necessary because as a patient, so I also have a unique perspective, I worked as I think many listeners know, I worked at Aetna for four years, so I sat on the payer side of things. And I’ve been a patient, right? And let me tell you something, when I’m sitting in front of my doctor, I want whatever he thinks is necessary. I don’t care what somebody down in Hartford, Connecticut who’s 600 miles away from me, is saying is necessary or not, but the payer is coming and saying, well, you know what, Justin, I’m not in the room. I’m looking at a digital transaction. And according to my rules and regulations, what you are seeking is not necessary.
How do we solve that? Can we solve that?
Well, that’s a great point, Justin, right? Because the payers relying on whatever clinical guidelines that they use and frankly that they have provided to the provider in advance of that procedure. So there’s knowledge on both sides of the house as to what the payer specific requirements or their specific medical guidelines look like. But what I see quite frankly, more often than not, is again, a breakdown in the communication. You can automate, and we are automating 99% of all of those interactions, and doing it in a way where there’s very, very little disconnect or disagreement between the payer and provider over whether something’s medically necessary or not. You’re talking 5% or 6% of the total volume of transactions that are coming through. What I think the provider would say is, tell me what I need to get to you, or submit to you, in order for you to make that medical necessity determination as quickly as possible. And I know that 95% of the time we are going to be in alignment. The 5% of the time that we’re not in alignment, tell me why you don’t think we’re in alignment and what I should be doing or looking at differently. And a lot of the times, as you know, right, that is, I didn’t include a particular lab result, or I didn’t include a copy of an image, or I didn’t include something that the payer needed for their rule set to make that medical necessity determination. The scenario you described certainly happens, where there’s disagreement over whether something’s medically necessary or not. But I think it’s a pretty small piece of the total volume of transactions that are coming through.
Yeah, I think it’s a small piece, but I think the dollar value is pretty frankly high. You look at what’s going on right now with Ozempic and Wegovy, if I’m pronouncing that correctly, right? And some payers are saying, sorry, not gonna give it to you. And other providers are like, I want to prescribe it to my patients. So, it’s that those things get, I think, a lot of visibility, if you will.
I think they do. They get a lot of visibility and that’s where, I think, as a patient, and particularly as an employer, you gotta be super thoughtful about plan design, right? Because again, remember the payer is not sort of independently setting these rules, or at least not company specific rules, right? They’re negotiating the terms and what’s on formulary and what’s not on formulary with the employer. And that’s the sort of fourth leg of the stool that we don’t talk about a lot, which is, what’s an employer willing to pay for as part of a plan and what’s gonna be out of network and what’s gonna be out of plan.
Yeah, you know, I’m really glad you brought up the employer because I think they are that fourth leg that people don’t talk about. And again, it’s another level of complexity in all this, right? So in some regard, my employer HR department is turning to me and going, Justin, we want nothing but the best care for you. You are a valued employee, we love you. And then the CFO’s going, hey, insurance company, lock it down. And then they’re turning to me as a employee and going, well, Justin, it’s not our fault, it’s the insurance company. Right?
And I don’t think that’s really the case.
You know, when you get into self-insured employers, that is very, very true, right? That it’s the employer making decisions about what’s going to be covered and what’s not going to be covered. And I think you’re right. I think a lot of the times it’s really easy to point to the plan and say, look, it’s not Availity, it’s Florida Blue who is saying you can’t- Well, no, actually it is us that’s saying we are not gonna cover Ozempic. We’ll cover a generic version, or we’ll cover some other treatment plan. But that’s just, and to your point, when you get into the really expensive stuff, I think for example, infusion therapy is a great example of one where the cost is super, super high, the efficacy is often debatable, right? IVIG for a variety of conditions is not FDA approved. I mean, it’s tricky.
Yeah. And it’s also interesting when you look at some of the employer sides of stuff. So, you know, here at Definitive Healthcare, we’ve got like 900 employees, but I also worked at GE back in the day when they had 300,000 employees, right? And so GE could afford to have a whole benefits analysis department that could go negotiate with the insurers to say, we’re gonna cover X and Y based on our statistical analysis. Here at DH, we don’t have that capability, right? We’re just kind of taking the plan, whatever comes off the shelf, from the employer based on how much money do you wanna spend Mr. CFO A, B, or C? Here’s the plan designed for you.
Right. Well, and add the other element of that to it, right? Because it’s all about assessing risk from a corporate perspective, right? It’s both what kind of plan do I want, but how much risk am I willing to take as an employer? Trust me, we have the same, we’re a little bit bigger than you guys in terms of people, but we have the same knockdown drag-outs around what we’re gonna cover. And ultimately someone is not gonna be happy about the decision. That’s what you really know.
You know, coming back to the provider for a second, we’re talking a little bit about, for example, you said you got 3 million providers and 300 plans in there. But when you think of a provider, and it’s again, this concept of medically necessary, that’s 300 different plans who may have a different definition of medically necessary. How does the provider think about that? Plan A says this is good, plan B says, hell no.
Well, and to your point a minute ago, it’s actually worse than that. The average provider, and don’t hold me to the numbers ‘cause I’ve seen ‘em recently but forgotten. But let’s say the average provider sees patients from 15 to 20 different health plans, right? Across a broad swath of the population. Commercial, Medicaid, Medicare, uninsured, whatever it may be. Well, remember particularly for the commercial side of it, to your point, there is no Aetna benefit, right? Or Blue Cross benefit or United Benefit. There are multiple versions of that benefit and contracts that get negotiated on an employer by employer basis. So even though it’s a patient walking in carrying a Cigna card, if it’s a Cigna employee for Definitive versus a Cigna employee for Availity, you can have a completely different benefit structure there. So where I think we’re headed with the conversation, is that’s where technology really has such an important role to play, right? As a provider, there is zero chance that I’m going to be able to keep up with 30 times 20, 600 plus different versions of a benefit. So I really have to rely upon tech and frankly information, ‘cause tech is enabling, it’s not a solution. It enables a solution. But on different types of information systems to make sure I know if it’s Justin walking in with his Aetna card under the Definitive plan that here’s what the benefit looks like, here’s what I can do, here’s what I’m required to do pre-service, versus Russ walking in with an Aetna card but potentially a very, very different different plan. And you have to automate, and I think this is kind of where we wanna go, you have to automate those workflows in a way where the provider spends very little time thinking about that. It should just be automatic. When you hand that card over and they run it through whatever system they’re on, whether it’s Epic or Allscripts or Cerner or whoever it may be, that the response that comes back is at a level of detail specific to you that they don’t have to pick up the phone and call and go, look, I know you just gave me coverage information for Justin, but are you aware that he is a Definitive employee? Because I’ve been through this before and I know their benefit design is a little different, and I’ve been, look, I mean, memories are a little long here, right? I’ve been dinged before because I didn’t get the auth pre-service and the entire claim got denied even though the auth would’ve been approved. The complexity of this is mind boggling. But that’s where I think companies like ours really have an important role to play in creating transparency at that granular, granular level so that providers know exactly what, we hear this from providers all day, every day. Just tell me what the rules are and I’ll play by the rules. I’m a Star Trek junkie, you know?
The Kobayashi Maru, right? Don’t put me in a game I can’t win. I don’t wanna play, I’m out.
Well, we’re gonna have to have another conversation about Star Trek ‘cause I’m watching all them right now on Paramount Plus. So we can have a whole advertiser, oh yeah, we can all go there. But Joel won’t let me do that. He needs me to stay on topic. So let’s speak about, staying on topic, I’ll ask you another question. Do you think we have made healthcare reimbursement too complex as a country or industry?
Yes, absolutely. Healthcare reimbursement is infinitely too complex. But we didn’t get here overnight and we’re not gonna fix it overnight. And a different question is, in the process of creating an employer sponsored plan, where as a consumer, I don’t have to think about going out and finding a health plan, negotiating my own benefit design, negotiating an individual premium, all that sort of stuff, right? Is the trade-off worth it from the consumer’s perspective? And frankly, is it worth it from the provider’s perspective? And I would submit, you know, the seesaw is a little bit balanced right now, quite frankly. It’s a painful process. I’m accident prone, you and I may have talked about this before. I had a bike crash a couple of months ago and crashed on a Saturday and I ended up at my local, I joked, my primary care doc is the Mayo ER. So I ended up at the Mayo ER getting checked out, right? I had some X-rays and MRIs and things ‘cause cracked my helmet and all that sort of stuff, which is great. I had a great experience, right? We’re blessed in Jacksonville to have Mayo just down the street. 30 days later I get notification from Mayo, your claim has been denied and you need to complete this form. And it was a form to document why this wasn’t an auto accident and thus covered under my auto insurance. ‘Cause if you looked at the ICD-10, and I need to go back and look at it, but it had something to do with a crash on the road for which there was an assumption made when the claim got submitted that there should be a associated auto claim with my medical claim, and maybe the auto was primary there. So now, then what happens? I start getting the notices from Mayo. “Hey, Mr. Thomas, your bill is 30 days late.” And that is an example of the layers of complexity that we’ve introduced into the system. And again, go back to intent, right? I think intent for all of this is generally good, but we’ve created this Rube Goldberg system of reimbursement that’s just incredibly difficult to understand.
Can it be fixed?
Yeah, absolutely can be fixed. And I don’t, I mean I’m a little biased, but my view of it, Justin, is the way to fix it is by solving the problem upfront. So, the higher the quality of the pre-service content and even point of service content, the more the provider knows pre-service, point of service, that you can then flow through the entire encounter all the way through billing, the more you can do to clean up the downstream reimbursement. So I’ll use a category that is particularly troublesome to me, which is overpayment recovery, right? So as you know, health plans overpay claims. They underpay claims for sure, but not as well known, they overpay claims by billions and billions of dollars every year. And they then hire firms to go chase providers to recover those billions and billions of dollars that they have inadvertently overpaid. And you get a lot of different reasons that it happens. I remember having a conversation with a senior health plan exec who owned that function for his plan. I won’t name the plan. And he proudly proclaimed to me that they had recovered a billion and a half dollars in 2019 in overpayments. And I looked at him, I’m like, why’d you overpay a billion and a half dollars in the first place? But again, it’s ingrained into how they operate today. So where we’re focused is, you know, garbage in, garbage out, right? Let’s make sure that the quality of the content that is submitted by the provider and the responses back to them both in terms of benefit, coverage, clinical, administrative authorizations, what do I need to know both administratively and clinically. The higher quality of content that you can move into that pre-service workflow and the more editing, the more engagement that you have before that claim was ever submitted, the better downstream response you’re going to have.
So, I’m hearing you talk to me a little bit about information asymmetry, information arbitrage, I know something you don’t know, so I’m gonna have a different financial transaction because of that. How do we inject more transparency into this claims process to eliminate some of that information asymmetry and ultimately build more trust? I mean, is there even a lack of trust there?
I think that asymmetry leads to a lack of trust because you can’t deny the fact that providers wanna provide healthcare. That costs money. And part of the payer’s job is to make sure that the cost of that healthcare is as efficient and as low. I mean, you want as high quality healthcare as you can get for as low as possible prices you can pay for it, generally speaking. And I think that asymmetry feeds the paranoia to a degree between providers and payers that, hey, if I don’t know something and I’m getting a denial from the provider’s perspective, then they’re up to something, right? There’s this intent to keep money that I’m owed. So, to the point that we were talking about earlier, again, the quality of the content upfront. You talk to providers, right? Tell me what I need to know as early as possible and I’ll play by your rules. Give me the content that I need to have, give me the rules that I need to have, but don’t wait till after I’ve already spent my money and my training to provide care for a patient to tell me, oh, by the way, this was not medically necessary. Or oh, by the way, you know, you prescribed- Here’s a great example, even on the pharmacy side. You prescribed X, doc, because you thought it was the most important or the best possible drug. Well, we don’t actually cover that, or we don’t cover that as primary, we only cover that as secondary and you have to have an authorization for that particular prescription. So yeah, I think you can get at the trust issues by getting at the information asymmetry issues. I think they go hand in hand.
But there’s also a yield problem and I hear people talk about the yield problem a lot, right? That it can’t cost me $1.25 to collect $1.00 of revenue.
How pervasive is that problem and is it getting any better or worse?
Yeah, another really good question, Justin. I think the problem is more pervasive in value-based programs than in fee for service, as you would expect, right? Because value-based programs are really, providers would say they’re risk shifting more than anything else. Payers would say no, you as a provider are in a better position to know what to do with a patient and we want to reward you and/or penalize you, on the other side of that, for making better or worse decisions. So I think conceptually, value-based makes a tremendous amount of sense. But to your point, there’s no value-based program. There are hundreds of different flavors of this thing and from the provider’s perspective, they just don’t have the manpower or the tech to be able to manage this kind of relationship, which is what they need to be able to do. So I think for value-based to really take hold and become pervasive, which I think they should to a large degree, that you’ve gotta have tech, just like with your basic billing services, you’ve gotta have tech that helps provide or understand, look, I’m dealing with Justin, he’s an Aetna patient. I know I’m going to get reimbursed at a higher rate if I get a hemoglobin A1C when he’s in the office tomorrow, right? That’s something that they will pay for in a value-based program ‘cause that’s a gap in his care that everyone has decided will lead to a better result if we are effectively managing his hemoglobin A1C. So again, I think you’ve gotta apply tech to the problem. A great example is, I don’t know if you’re spending time with the folks at Noona, great example of tech that can consolidate all of those payer rules into a single application and tell the provider, look, you got Justin coming in today. Here’s what you need to know about Justin today. And Justin’s your Aetna patient. You got Russ coming in, he’s your Florida blue patient. Here’s what you need to do for Russ. So yeah, I think tech can help drive a lot of improvement in yield, which is what providers ultimately care about.
But it’s almost like we’re gonna layer a second set of rules on top. ‘Cause we’re not going to value-based care 100% tomorrow. I don’t think we’ll ever get to 100% value-based care. So suddenly I’m looking at, I got one set of rules for fee for service. I got another set of rules for value-based care. I got two different ones that I’m taking the risks. The other ones, the payers are taking the risk. We said earlier we thought the healthcare system was overly complex. I feel like we’re making it even more complicated.
Yeah, and I’ll just go back to my theme, right? Which is we are, unless we figure out how to apply tech, so now you get one of my other big issues, which is I think point solutions are great for pilots, but I think point solutions have to quickly morph into enterprise solutions that serve all of these different models and payers in a scaled model. So to your point, and again, I mention Noona only because we’re doing some work with them specifically and the theme there is, how do we integrate payer specific value-based rules into the Availity workflow so that whether it’s a fee for service customer patient or a value-based patient, or more likely to your point, a blend, right? There’s basic stuff we pay for on a fee for service model and then there’s a kicker for value based. All that has to be addressed in a single workflow.
So, everyone’s talking about it these days. Is AI the answer? It seems to fix every other problem, right?
I hope AI is an answer ‘cause we just spent a bunch of money buying an AI platform. So look, here’s what I think about it. Artificial intelligence is a tool just like any other tool in the toolbox. There are phenomenal applications of AI in healthcare. What we’re doing with auth automation now, with the auth AI product, ‘cause it was originally Verata and then Olive owned it and we bought it from Olive. It’s spectacular, Justin. We are taking that auth determination process, which can be as long as days, and automating it into a 90 second response all the way through to medical necessity. And our tool is getting smarter with every auth that it approves or denies. And let’s be super clear, right? Availity is not approving auths. Availity is not denying auths. We’re applying the payer’s rules in our tech to get the provider the answer in 90 seconds. That is a phenomenal, I mean our NPS on that product is 70, 80, something like that, right? Providers love it. And here’s the fascinating thing about it. Here’s some data that you’ll love. Since we went live with it in Florida with Florida Blue, we have seen a 7% reduction in denials, so this is taking the auth process from days sometimes to 90 seconds. We give a response in 90 seconds. We’ve seen a 7% reduction in denials with zero increase in utilization.
So think about it, right? ‘Cause you would expect you deny fewer auth requests, utilization is going to spike. And it’s not. So, why is that? The right tool will help a provider. They work through the process to reach a point in some cases where they say, you know, I don’t actually meet the guideline for this procedure for this patient yet, so let me just pull the request back. So the third piece of data is total volume of requests has also decreased. So, there’s a great application of AI creating transparency around the rules, giving providers a tool to automate that workflow that from the payer’s perspective, and let’s be clear, payers work for you and me, right? We pay them to manage this stuff. From our perspective as a patient, isn’t increasing what some might call unnecessary utilization of a procedure. And that’s one of many examples that you see now in healthcare of the application of AI. And I think you have to be super responsible about it. I mean, one of the things that we are finalizing is our ethical AI policy as a company. What are the rules of the road that we’re going to follow? One rule for us is we don’t sell data, period, full stop. So we do not have a- We’ll process close to $3 trillion worth of claims this year and we sell zero data associated with that. So I think you have to have rules of the road and guidelines around the ethical application of not just AI itself, but the data that comes out of it. But I think AI, there are phenomenal use cases, right? Both from the provider payer’s perspective, but also internally how we work as a company, applying AI to even the way that we engineer products is really exciting for us.
So as our listeners could tell, I could geek out about this with you all day long. Star Trek or insurance claims. It’s all kind of there. But I gotta ask you my one last big question for today, which, and I realize the irony of asking somebody whose business is based on sitting in the middle of this complexity and trying to negotiate payers and providers, would we be better off as a country throwing it all out the window and moving to a UK NHS, or Canadian socialist healthcare model?
You’ve been to the DMV recently?
That’s not the healthcare experience that I want. I mean, I think we have one of the best healthcare systems in the world. It’s certainly not the most efficient and there’s a lot of room for improvement. But whether it’s me crashing on my bicycle and having to choose the right place to go to get taken care of immediately, or have a family member with an illness or something to be treated. I just think we have a great system. It’s not perfect by any stretch of imagination. There’s a tremendous amount of room for improvement. But when I think about the future, Justin, I’m a believer in capital markets and free markets and I think the next wave for healthcare is what some are calling Healthcare 3.0. I don’t know if you follow folks like Andrew Huberman and Peter Attia and people like that who are really focused on not just living long, but health span, having really, really healthy lives for as long as possible. And I think the evolution of healthcare is not treating illness or sickness as much as preventative, proactive, you know, help me be a healthier person all day, every day, not just when I have something to be treated. And I’m just not convinced that a system like that can evolve in anything other than a, with all due respect to people who feel differently in any other system, than a capitalistic kind of model, right? Someone is going to have some breakthrough. Like, I can see a plan design that says, look, we are only taking people as a plan with these particular health factors because we want to treat lifestyle and long-term healthiness moreso that their plans who are really, really good at treating the four horsemen, right? But that’s not what we wanna do. We want to treat people who are, or we want to ensure people who are really focused on their long-term health, they’re gonna pay less for medical benefits. They’re gonna have things like CGM monitors covered for everyone, right? ‘Cause that is such a great indicator, not of just whether you’re sick or not, but how to get the most out of your body during an athletic activity. That’s where I think the future’s going. And I think that has to evolve within the context of a for-profit system.
Excellent. Russ, this has been a blast. Thanks for taking the time to talk with me today. I learned so much. Good luck with everything.
Thanks, Justin. Really do appreciate the time with you and keep doing what you’re doing. I love it.
And for all our listeners out there, thank you again for listening to Definitively Speaking, a Definitive Healthcare podcast. Please join me next time for a conversation with Charles Gellman, CEO and Co-Founder of HiDO Health. HiDO Health is developing AI-assisted robotics, a patient friendly device accompanied with a mobile application that helps automate home care by assisting patients with medical compliance. AI is hot these days, and Charles is one of the foremost public speakers on the topic of AI in healthcare. So I’m looking forward to what should be a great discussion. If you like what you’ve heard today, please remember to rate, review, and subscribe to the show on Apple Podcasts, Google Podcast, Spotify, or wherever you get your podcast. To learn more about how healthcare commercial intelligence can support your business, please follow us on X, formerly known as Twitter, @definitivehc, or visit us at definitivehc.com. Until next time, take care. Please stay healthy. And remember the definition of necessary depends on where you sit.